Ocean Holds Opioid Alternatives

In the United States, we are in desperate need of opioid alternatives when it comes to the treatment of pain. It is fair to say that the problems we face with opioid addiction today, would not be so severe if opioid painkillers were not so effective. Calls to look for alternative forms of pain management have been loud in recent years, yet physicians may be scratching their heads about what to prescribe instead. Unfortunately, many pain sufferers do not respond to meditation and acupuncture. And frankly, severe pain can require the use of powerful opioids.

Those tasked with developing opioid alternatives for pain relief are researchers at any one of a number of colleges/universities around the country. But effective research requires large teams working thousands of hours. The point being, finding opioid alternatives could take years to accomplish—when we need solutions now. Nevertheless, researchers trudge sedulously to find such alternatives, sometimes looking for answers in the strangest of places.

A number of medications currently used today have their origins in the tropical rain forests of the world. But when it comes to pain management, new options may be residing in the deep blue sea. Meet Conus regius, a species of sea snail that is both predatory and venomous.

Conus regius (Credit: Zsnapper)

Researchers at the University of Utah have isolated a compound from the snail's venom that acts on a pain pathway different from the pathway targeted by opioid painkillers, GEN reports. The compound, RgIA4, was successful at blocking alpha9alpha10 nicotinic acetylcholine receptors (nAChR) pain pathway receptors in rodent models. The research was published online in the Proceedings of the National Academy of Science.

"RgIA4 works by an entirely new pathway, which opens the door for new opportunities to treat pain," said J. Michael McIntosh, M.D., professor of psychiatry at the University of Utah Health Sciences. "We feel that drugs that work by this pathway may reduce the burden of opioid use." 

The Conus regius sea snail could be vital for the development of new painkillers that do not carry the same risks as opioids. What’s more, while RgIA4 works its way through the body in only 4 hours, the pain-relieving effects of the compound were still working 72 hours after the injection, according to the article. Dr. McIntosh points out that the majority of painkillers used today are not sufficient in addressing chronic pain. Better alternatives may be found in the ocean. Really exciting stuff.

“Nature has evolved molecules that are extremely sophisticated and can have unexpected applications," says Baldomera Olivera, Ph.D., professor in biology at the University of Utah. "We were interested in using venoms to understand different pathways in the nervous system."

Alternatives to Opioids (ALTO)

If you experience an injury that requires a trip to the local emergency room, there is a good chance that you will be prescribed an opioid narcotic for the pain and will be told to follow up with your primary care physician. If you are still experiencing pain when you see your family doctor, there is an even greater chance that you will be prescribed more painkillers. In fact, nearly half of all opioid prescriptions written in the United States come from primary care physicians. One does not have to take opioids for too long before dependence develops, a slippery slope towards addiction which began back at the emergency room. So, what would happen if emergency room doctors only prescribe opioids as a last resort?

At one emergency room in New Jersey, the chairman of emergency medicine has decided to answer that question. At St. Joseph's Regional Medical Center in Paterson, NJ, doctors have begun using opioid alternatives to treat pain, keeping opioids off to the side for last ditch treatment efforts only, the Associated Press reports. The program, Alternatives to Opiates (ALTO), has been used since January, and in the first two months 75 percent of the emergency rooms 300 patients did not receive prescription opioids.

This month, the Centers for Disease Control and Prevention (CDC) released new prescribing guidelines, calling on primary care physicians to only use prescription opioids when every other alternative proves ineffective. While the guidelines are not something the CDC is normally responsible for creating, due to the dire nature of this epidemic every health agency needs to work together to put a stop to prescribing opioids when they are unnecessary.

Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing points out that emergency rooms are the front lines of the opioid crisis we face, according to the article. He supports the doctors at St. Joseph's, utilizing alternative forms of pain management.

"In many cases, we're exposing people to opioids when we don't need to be," said Kolodny.